Healthcare Provider Details

I. General information

NPI: 1366055790
Provider Name (Legal Business Name): AMANDA LEWIS, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 ABOUT TOWN PL
MORGANTOWN WV
26508-5838
US

IV. Provider business mailing address

7000 COOMBS FARM RD STE 202
MORGANTOWN WV
26508-0803
US

V. Phone/Fax

Practice location:
  • Phone: 304-413-5002
  • Fax:
Mailing address:
  • Phone: 304-413-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LEWIS
Title or Position: OWNER/CLINICAL THERAPIST
Credential:
Phone: 304-413-5002